title: Two-week wait symptoms are prevalent in screened patients with a positive faecal occult blood test but do not predict cancer.
abstract: OBJECTIVE
  Lower gastrointestinal (LGI) symptoms are prevalent in patients screened for bowel cancer yet do not predict a finding of cancer. This study evaluates symptoms in patients with these characteristics against the 2-week wait (2ww) criteria to determine whether they predicted cancer in these patients.
  
  
  METHODS
  A prospective cohort study was performed. Patients with a positive faecal occult blood (FOB) test attending our unit over a 7-month period were included. Data on symptom prevalence, frequency and duration were collected and assessed against the 2ww criteria. Associations between symptom prevalence and patient outcome were investigated using the χ(2) test.
  
  
  RESULTS
  Three hundred and ninety-seven patients were included and 37 (9%) were found to have colorectal cancer (CRC). The prevalence of undefined LGI symptoms was 71% and appeared comparable between those with and without CRC (65 vs 72%, P = 0.385). 2ww symptoms were reported in 147 (37%), with 2ww change in bowel habit in 10% and 2ww rectal bleeding in 31%. 2ww symptom prevalence was similar in those with and without cancer (38 vs 37%, P = 0.915). No significant differences in overall 2ww prevalence or prevalence of individual 2ww symptoms were demonstrated between those with a normal colonoscopy or one showing cancer, polyps or other pathology. Twenty nine per cent of patients with 2ww symptoms had reported these to their GP.
  
  
  CONCLUSIONS
  Undefined LGI symptoms are prevalent in FOB-positive patients but do not predict CRC. 2ww symptoms are also highly prevalent, yet similarly fail to predict cancer. Further efforts to increase public awareness of cancer symptoms are required, whilst false reassurance from a negative FOB result should be discouraged.
authors.affiliation: Department of Colorectal Surgery, Cheltenham General Hospital, Cheltenham, UK.
authors.forename: P G
authors.initials: PG
authors.lastname: Vaughan-Shaw
authors.forename: J
authors.initials: J
authors.lastname: Cutting
authors.forename: N
authors.initials: N
authors.lastname: Borley
authors.forename: T
authors.initials: T
authors.lastname: Brooklyn
authors.forename: J M D
authors.initials: JM
authors.lastname: Wheeler
mesh_terms: D015746:Abdominal Pain / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003248:Constipation / Q000453:epidemiology*; D057210:Delayed Diagnosis / Q000517:prevention & control; D003967:Diarrhea / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum; D017678:Sex Distribution; D014850:Waiting Lists; D015431:Weight Loss
keywords: Colorectal neoplasms/diagnosis; early detection of cancer; programme evaluation; screening